ABSTRACT
Heterotopic ossification (HO) is excess bone growth in soft tissues, typically juxta-articular and interfascicular, with varying incidence. This excess bone growth has been well-documented in cases of traumatic amputation but less frequently observed in cases of nontraumatic amputation. Symptomatic heterotopic ossification usually includes pain during prosthetic use with management involving prosthetic adjustments for comfort. This atypical case highlights a patient with a nontraumatic amputation and a proximal-oriented large spur formation that was not painful with ambulation but with doffing his prosthesis.
Subject(s)
Amputation, Traumatic , Ossification, Heterotopic , Adult , Amputation, Surgical , Amputation, Traumatic/diagnostic imaging , Humans , Ossification, Heterotopic/diagnostic imaging , Ossification, Heterotopic/etiology , Ossification, Heterotopic/surgery , Pain , RadiographyABSTRACT
A typical autoimmune neuro-inflammatory disease (NID), multiple sclerosis (MS), is more prevalent in women than in men. Majority of patients with MS are of child-bearing age; therefore, occurrence in pregnancy is common. Herein, we review proposed disease mechanisms and suggest therapeutic interventions, focusing on the remarkable pregnancy-induced protection against MS - insofar considered as best, albeit temporary therapy for such harsh NID. Current drugs used for MS therapy in pregnancy are described. Role of non-pregnancy-specific agents considered involved in amelioration of disease is also presented. This review highlights pregnancy-derived neuro-protective agents, proposing that unique pregnancy-induced immune-protective environment is because of the conceptus and its direct action. The essential role of pre-implantation factor (PIF) in pregnancy is delineated. Finally, PIF immune-modulatory effects and efficacy in chronic model of neuro-inflammation to reduce inflammation and paralysis coupled with neural regeneration is presented. Overall, we postulate that this embryo-derived-compound holds great promise to improve MS and possibly neuro-inflammation in general.
Subject(s)
Multiple Sclerosis/drug therapy , Multiple Sclerosis/immunology , Peptides/therapeutic use , Female , Humans , Inflammation , Male , Nerve Regeneration , Neuroprotective Agents/metabolism , Paralysis , Pregnancy , Pregnancy Complications/drug therapy , Th1 Cells/metabolism , Th2 Cells/metabolism , Vitamin D Deficiency , alpha-Fetoproteins/therapeutic useABSTRACT
OBJECTIVE: Preimplantation factor (PIF) is a novel, 15 amino acid peptide, secreted by viable embryos. This study aims to elucidate PIF's effects in human endometrial stromal cells (HESC) decidualized by estrogen and progestin, which mimics the preimplantation milieu, and in first-trimester decidua cultures (FTDC). STUDY DESIGN: HESC or FTDC were incubated with 100 nmol/L synthetic PIF or vehicle control. Global gene expression was analyzed using microarray and pathway analysis. Proteins were analyzed using quantitative mass spectrometry, and PIF binding by protein array. RESULTS: Gene and proteomic analysis demonstrate that PIF affects immune, adhesion, and apoptotic pathways. Significant up-regulation in HESC (fold change) include: nuclear factor-k-beta activation via interleukin-1 receptor-associated kinase binding protein 1 (53); Toll-like receptor 5 (9); FK506 binding protein 15, 133kDa protein (2.3); and Down syndrome cell adhesion molecule like 1 (16). B-cell lymphoma protein 2 was down-regulated in HESC (21.1) and FTDC (27.1). Protein array demonstrates PIF interaction with intracellular targets insulin-degrading enzyme and beta-K+ channels. CONCLUSION: PIF displays essential multitargeted effects, of regulating immunity, promoting embryo-decidual adhesion, and regulating adaptive apoptotic processes.
